View More View Less
  • 1 Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
  • 2 Department of Transplantation and Surgery, Semmelweis University, Baross u. 23, H-1082, Budapest, Hungary
Restricted access

Abstract

Introduction: Biliary strictures remain a key problem after liver transplantation. Anastomotic strictures are treated by surgery or interventional therapy. Intrahepatic stenosis requires retransplantation. For bridging, percutaneous and endoscopic interventions are used. The extent of the strictures may have an important role in therapy planning. Methods: Strictures were divided into four zones (1: extrahepatic, not included in this study; 2: hilar; 3: central; 4: peripheral). Twenty patients were treated with balloon dilatation/stent implantation/retransplantation/supportive care (Zone 1: 0/0/0/0; Zone 2: 8/7/2/0; Zone 3: 7/5/2/1; Zone 4: 1/1/3/1). Results: Mean follow-up time was 48 months. In Zone 2, one patient died as a result of recurrent hepatocellular carcinoma (HCC), and seven patients are alive, five after stent placements and two after retransplantation. Four patients are alive in Zone 3: all had stent placements and one later retransplantation. One patient died after retransplantation, two on the waiting list, and one due to chronic liver failure. One patient is alive in Zone 4 after early retransplantation, and three died. Conclusion: Percutaneous therapy is safe and effective in intrahepatic biliary stenosis after liver transplantation. It can provide the cure or bridge retransplantation. Based on zonal classification, we recommend the following treatments: Zone 4: early retransplantation; Zone 2: minimally invasive therapy; Zone 3: individual decisions.

  • 1. K. Abdullah 2005 Incidence and management of biliary complications after orthotopic liver transplantation: ten years' experience at King Fahad National Guard Hospital Transplant Proc 37 3179 3181.

    • Search Google Scholar
    • Export Citation
  • 2. L. Polese 2007 Endoscopic treatment of bile duct complications after orthotopic liver transplantation Transplant Proc 39 1942 1944.

  • 3. A.P. Holt 2007 A prospective study of standardized nonsurgical therapy in the management of biliary anastomotic strictures complicating liver transplantation Transplantation 84 857 863.

    • Search Google Scholar
    • Export Citation
  • 4. C.B. Bellido 2010 Indications for and survival after liver retransplantation Transplant Proc 42 637 640.

  • 5. R.C. Verdonk 2007 Nonanastomotic biliary strictures after liver transplantation, part 2: Management, outcome, and risk factors for disease progression Liver Transpl 13 725 732.

    • Search Google Scholar
    • Export Citation
  • 6. J.F. Glockner 1999 Vascular or ischemic complications after liver transplantation AJR Am J Roentgenol 173 1055 1059.

  • 7. C. Margarit 1998 Biliary complications secondary to late hepatic artery thrombosis in adult liver transplant patients Transpl Int 11 Suppl1 S251 S254.

    • Search Google Scholar
    • Export Citation
  • 8. C.I. Buis 2006 Causes and consequences of ischemic-type biliary lesions after liver transplantation J Hepatobiliary Pancreat Surg 13 517 524.

    • Search Google Scholar
    • Export Citation
  • 9. C.I. Buis 2007 Nonanastomotic biliary strictures after liver transplantation, part 1: Radiological features and risk factors for early vs. late presentation Liver Transpl 13 708 718.

    • Search Google Scholar
    • Export Citation
  • 10. R. Marudanayagam 2010 Liver retransplantation in adults: a single-centre, 25-year experience HPB (Oxford) 12 217 224.

  • 11. D. Eurich 2009 Successful endoscopic and surgical management of non-anastomotic biliary strictures after liver transplantation — case report Ann Transplant 14 47 51.

    • Search Google Scholar
    • Export Citation
  • 12. F. Filipponi 2002 Extended right hepatectomy as graft-saving option in non-anastomotic biliary strictures after liver transplantation Hepatogastroenterology 49 1679 1681.

    • Search Google Scholar
    • Export Citation
  • 13. J.W. Ostroff 2010 Management of biliary complications in the liver transplant patient Gastroenterol Hepatol (N Y) 6 264 272.